School Bullying/Harassment Reporting

First name of person reporting

Last Name of Person Reporting

How can we contact you if needed?

Your Email

Your Phone

School

First name of victim Question is mandatory

Last name of victim Question is mandatory

First name of alleged harasser or bully Question is mandatory

Last name of alleged harasser or bully Question is mandatory

Date of incident Question is mandatory

(MM/DD/YYYY)

Location of incident Question is mandatory

Type of Harassment Question is mandatory

Name of Witnesses

Any other information

How often has this issue occurred?

This was the first time

5 times or less

6 times or less

Tell us who you are Question is mandatory

(Select one or more)

Wharton Independent School District Student

Wharton Independent School District Parent/Guardian

Wharton Independent School District Employee

Community Member